
*Core Stanford Anesthesia Cognitive Aid Group contributors listed here in random order
Steve Howard, Larry Chu, Sara Goldhaber-Fiebert, David Gaba, Kyle Harrison
See http://emergencymanual.stanford.edu for latest updates, Creative Commons licensing BY-NC-ND
HOW THIS WORK CAME TO BE:
This Emergency Manual has a long history, evolving from decades of prior work on both Crisis Resource Management
(CRM) concepts and cognitive aids for critical incidents. The 1994 book entitled ‘Crisis Management in Anesthesiology’ by
Dr. David Gaba, Dr. Steven Howard, and Dr. Kevin Fish provided the initial foundations for this project. Their simulation
group has been involved in developing cognitive aids for operating rooms in the Palo Alto VA and then a national VA
project, each with bulleted points for many critical events. Observing that practitioners often miss key actions under stress,
Drs. Harrison and Goldhaber-Fiebert along with Dr. Geoff Lighthall, Dr. Ruth Fanning, Dr. Howard, and Dr. Gaba
developed several iterations of pocket cards for perioperative critical events, including some with rhythm strips, icons, and
color design. In 2004, Dr. Larry Chu conceived of adapting crisis management cognitive aids to a more visually striking
format for a new book he envisioned for today’s highly visual millennial learners. This became The Manual of Clinical
Anesthesiology, published in 2011. To create the current Emergency Manual, the Stanford Anesthesia Cognitive Aid
Group was formed. All team members have had integral roles. Dr. Larry Chu, who directs the Stanford AIM (Anesthesia
Informatics Management) lab provided the new graphics and layout, applying his design skills and an understanding of
user interface to make the content more easily usable. Drs. Sara Goldhaber-Fiebert, Kyle Harrison, Steven Howard, and
David Gaba worked jointly to provide the content, including exact phrasing, ordering, and emphasis, as well as iterative
simulation testing to revise both content and design elements. Observing how cognitive aids are used by teams during
hundreds of simulated crises has been crucial for pilot testing throughout. We hope that this Emergency Manual will
support both education and patient safety efforts. Effective use has included pre-event review, post-event team debriefing,
and ‘during’ critical event management—the latter particularly after adequate help has arrived or when the patient is
sufficiently stable for a clinician to pause from acute care actions. We encourage the use of this Manual and welcome
feedback from all practitioners.
Acknowledgments: We appreciate the faculty and residents at Stanford and VA Palo Alto anesthesia departments for
their support of the development and implementation of the emergency manual. We are especially grateful to our chair,
Dr. Ron Pearl, for helping us make this project a reality. We are grateful to Barbara Burian for her expertise in human
factors and cognitive aid design reflected in the design of Version 3. While references are not written on each event for
space, we have tried to integrate the most pertinent clinical information from published literature for each event, including
practical publications e.g. A-ACLS modifications to AHA ACLS algorithms, ASA difficult airway algorithms, ASRA LAST
guidelines, MHAUS poster, and appreciate the work of their developers. We thank all our colleagues from the Emergency
Manuals Implementation Collaborative (EMIC), a global group fostering the dissemination, implementation, and effective
use of emergency manuals to enhance patients’ safety. Join EMIC at www.emergencymanuals.org.
Disclaimer: The material in this Manual is not intended to be a substitute for sound medical knowledge and training.
Clinicians should always use their clinical judgment and decision making for patient management. Since treatment for the
medical conditions described in this Manual can have variable presentations, departure from the information presented
here is encouraged when appropriate.
APPROPRIATE CITATION OF THIS EMERGENCY MANUAL
Stanford Anesthesia Cognitive Aid Group*. Emergency Manual: Cognitive aids for perioperative clinical events. See
http://emergencymanual.stanford.edu for latest version. Creative Commons BY-NC-ND. 2013 (creative
commons.org/licenses/by-nc-nd/3.0/legalcode). *Core contributors in random order: Howard SK, Chu LK, Goldhaber-
Fiebert SN, Gaba DM, Harrison TK.
MANUAL OF CLINICAL ANESTHESIOLOGY
Much of the work in this Anesthesia Emergency Manual was adapted from cognitive aids originally published in Appendix
of Crisis Management Algorithms in Anesthesia in the Manual of Clinical Anesthesiology, edited by Larry Chu and Andrea
Fuller, published by Lippincott Williams & Wilkins, 2011. The authors were*: Harrison TK (21), Goldhaber-Fiebert SN (21),
and Chu L (21), as well as on specific cognitive aids, contributions by: Lighthall G (2),
PRODUCED BY THE STANFORD ANESTHESIA
INFORMATICS AND MEDIA LAB (AIM)
TESTED BY THE STANFORD SIMULATION GROUP
AND THE STANFORD ANESTHESIA INFORMATICS